ABSTRACT
Encefalopatia de Wernicke (EW) e síndrome de realimentação (SR) são duas condições frequentemente coexistentes, subdiagnosticadas e que podem implicar prognóstico reservado após sua instalação. Sua identificação precoce representa um desafio para os intensivistas, haja vista a falta de sensibilidade e especificidade das manifestações clínicas. Apresenta-se um relato de caso de uma paciente portadora de esquizofrenia paranoide, sem histórico de abuso de álcool, que desenvolveu quadro de coma irreversível após greve de fome, sendo feito diagnóstico tardio de EW associada a SR. Descreve-se a evolução clínica e neuropsiquiátrica com o intuito de enfatizar a necessidade crucial de alta suspeição diagnóstica, com reposição vitamínica imediata, vigilância de distúrbios eletrolíticos e progressão parcimoniosa do aporte nutricional. (AU)
Wernicke encephalopathy (WE) and refeeding syndrome (RFS) are two often coexisting, underdiagnosed conditions that may involve a poor prognosis after their onset. Early identification represents a challenge for intensivists, given the lack of sensitivity and specificity of clinical manifestations. We report a case of a patient with paranoid schizophrenia, without a history of alcohol abuse, who developed irreversible coma after a hunger strike, with a late diagnosis of WE associated with RFS. The clinical and neuropsychiatric outcomes are described herein in order to emphasize the crucial need for a high diagnostic suspicion, with immediate vitamin replacement, monitoring of electrolyte disorders, and gradual progression of nutritional support. (AU)
Subject(s)
Humans , Female , Middle Aged , Wernicke Encephalopathy/diagnosis , Coma/etiology , Refeeding Syndrome/diagnosis , Starvation/complications , Delayed DiagnosisABSTRACT
Abstract Objective: To describe the case of two siblings with severe protein-calorie malnutrition due to abuse by starvation. Cases description: The two patients were simultaneously referred to the Hospital Municipal, where they were admitted to the Pediatric Gastroenterology clinic of a university hospital for diagnostic investigation of the cause of severe malnutrition and screening tests for Celiac Disease, Cystic Fibrosis and Environmental enteropathy among others. The exams were all normal, and after detailed research on the interactions of this family, we reached the conclusion that the malnutrition was due to abuse by starvation. The children spent approximately two months in the hospital, receiving a high-protein and high-calorie diet, with significant nutritional recovery. Comments: Abuse by starvation, although rare, should always be considered of as one of the causes of child malnutrition and pediatrician should be aware of the child's development, as well as the family interactions, to prevent more severe nutritional and emotional consequences in the future.
Resumo Objetivo: Descrever os casos de dois irmãos acometidos de desnutrição proteico-calórica grave causada por abuso por privação alimentar. Descrição dos caso: Os dois pacientes vieram simultaneamente encaminhados de hospital municipal, onde estavam internados, ao Ambulatório de Gastrenterologia Pediátrica de um hospital universitário para investigação diagnóstica da causa de desnutrição grave. Foram feitos exames para pesquisa de doença celíaca, fibrose cística e enteropatia ambiental, entre outras. Os exames mostraram-se todos normais e, após investigação detalhada sobre o relacionamento dessa família, chegou-se à conclusão de que a desnutrição tinha como causa o abuso por privação alimentar. As crianças passaram cerca de 2 meses internadas, receberam uma dieta hiperproteica e hipercalórica, com recuperação nutricional significativa. Comentários: O abuso por privação alimentar, embora raro, deve sempre ser pensado como uma das causas de desnutrição infantil, deve o pediatra estar atento ao desenvolvimento da criança, bem como ao seu relacionamento familiar, para evitar consequências nutricionais e emocionais mais graves no futuro.
Subject(s)
Humans , Male , Child, Preschool , Child , Starvation/complications , Child Abuse , Protein-Energy Malnutrition/etiology , Severity of Illness Index , SiblingsSubject(s)
Child , Fasting , Humans , Ileal Diseases/etiology , Intussusception/etiology , Islam , Male , Religion and Medicine , Starvation/complicationsABSTRACT
Eighteen male albino rats were classified into three groups: A control group, five-day starving group and a re-fed group after starvation group. The pancreatic tissue was subjected to light and electron microscopic studies [EM]. The pancreatic acini of the starved group showed wide lumen lined with pyramidal cells. Whereas, the beta cells of the islets revealed marked decrease of the aldehyde- fuchsin positive granules. After five-day starvation, EM study showed a decrease in the zymogen granules in the acinar cells. Also the rough endoplasmic reticulum was either dilated in the form of vacuoles or shortened and fragmented. The mitochondria became smaller in size with loss of their cristae. The nucleus showed a tendency to peripheral chromatin margination. The beta cells were degranulated, whereas the alpha cells were well granulated. These changes may be considered as an adaptive response to the fasting state. Re-feeding of the rats for five days after starvation was associated with some regenerative changes of the acinar cells in the form of partitioning and budding off of newly formed mitochondria and an increased number and well organization of rough endoplasmic reticulum
Subject(s)
Starvation/complicationsABSTRACT
La estimación de las demandas metabólicas está sujeta a una gran variabilidad derivada de la talla,el peso,la edad,la actividad física,la ADE y el aumento de demandas metabólicas del proceso patológico.La calorimetría indirecta,efectuada con los modernos monitores metabólicos(en este estudio se utilizó el MGMTWO, Medicor Inc.) dan una buena estimación del GBE.En el presenteestudio se muestra la utilidad del GBE medido y expresado en índice de superficie.En el enfermo quirúrgico se utilizó el indice catabólico de Bristrian para estimar la magnitud del estrés. Se efectuaron 171 observaciones en 85 sujetos,que muestran datos significativos en los siguientes aspectos:confiabilidad del GBE medido y expresado por índice de superficie; relación de la edad con el GBE; influencia del postoperatorio y la sepsis sobre el GBE y el IC; relación del aporte calórico nitrogenado sobre el balance nitrogenado en función del IC; utilización proteica y grado de estrés, y acción dinámica específica del aporte calórico administrado.